Exposures For Fear Of Breathlessness
Fearful responses to benign physical sensations such as breathlessness are common in several disorders, most notably panic disorder (with and without agoraphobia). Interoceptive exposure or ‘symptom induction’ is an effective treatment for addressing these fears, typically preceded by the development of a fear ladder or exposure hierarchy. It involves strategically inducing somatic symptoms associated with threat appraisals while encouraging the client to maintain contact with these sensations. Clients sometimes find it difficult to develop appropriate exposure tasks or identify manageable ‘steps’ between behavioral experiments. The Exposures for Fear of Breathlessness information handout is designed to help clients and therapists identify feared stimuli, develop exposure hierarchies, and plan appropriate exposure exercises and behavioral experiments. It also contains information about safety-seeking behaviors which may need to be addressed during exposure.
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Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
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Introduction & Theoretical Background
The fears that people struggle with can be organized according to their focus. Tolin (2012) suggests that the most common sources of fear relate to:
- Specific situations or objects (e.g., fear of dogs, fear of crowded places)
- Bodily sensations (e.g., heart palpitations, dizziness)
- Social and performance situations
- Obsessive fears
- Excessive worries
- Post-traumatic fears (e.g., beliefs that one is still in danger even after the threat has passed, or memories of trauma which are accompanied by high levels of fear)
Exposure is one of the most effective interventions for overcoming fear (Hofmann & Smits, 2008). It involves individuals repeatedly facing their fears to reduce their fearful responses and reverse the patterns of avoidance that perpetuate them (Springer & Tolin, 2020). Exposure is a first-line intervention for some conditions (such as phobias), and is an essential treatment component for many others (such as panic, social anxiety, OCD, and PTSD).
Therapist Guidance
We’ve talked about how exposure can help people overcome fear. I’d like to show you some examples of how other people have used it to address difficulties like yours. We can use these examples to think about which exposure exercises you might find helpful. Can we look at it together?
Useful questions to support this tool include:
Which items on this list would make you feel afraid or anxious?
Which items would you usually avoid because of your fear?
Which items would you endure with distress or discomfort?
Can you think of any other scenarios that would make you feel afraid?
Which safety behaviors do you use to cope with your fear?
Can you think of any other safety behaviors or coping strategies you sometimes use?
Does the process of facing your fears make sense? How might you start exposure?
How could you enhance the exposure(s) you are planning to
References And Further Reading
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford.
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. Basic Books.
Chambless, D. L., Beck, A. T., Gracely, E. J., & Grisham, J. R. (2000). Relationship of cognitions to fear of somatic symptoms: A test of the cognitive theory of panic. Depression and Anxiety, 11, 1-9. DOI: 10.1002/(SICI)1520-6394(2000)11:1<1::AID-DA1>3.0.CO;2-X.
Clark, D. M., Salkovskis, P. M., Ost, L. G., Breitholtz, E., Koehler, K. A., Westling, B. E., Jeavons, A., & Gelder, M. (1997). Misinterpretation of body sensations in panic disorder. Journal of Consulting and Clinical Psychology, 65, 203–213. DOI: 10.1037/0022-006X.65.2.203.
Craske, M. (2015). Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. Verhaltenstherapie, 25, 134-143. DOI: 10.1159/000381574.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to